Keeping Heart Wives’ Group Registration Name* First Last Email* Mobile*Organization* Address* Street Address City State / Province / Region ZIP / Postal Code Birthday* Month Day Year Favorite Beverage Favorite Snack Any Food Allergies? Name of Significant Other Kids' Names & Ages If someone else handles your scheduling and/or communications, please add their name and email:Assistant - Name Assistant - Email HiddenType Cohort #*Cohort 001/2, Wed AM 8 am-12 noonCohort 003, Wed PM 1–5 pmCohort 005, Thurs AM 8 am-12 noonCohort 006, Thurs PM 1–5 pmHiddenCohort - Hidden for Now* Executive Leaders Entertainment Executive Leaders Emerging Leaders Payment Option* Pay in Full via Check - $12,500 Contact me to discuss another option Payment Option* Pay in Full via Check - $6,250 Contact me to discuss another option Cohort Total Price: Cohort Total Price: Pay Monthly Price: Pay Monthly Price: Discount Price: Discount Price: Pay Monthly - DepositDeposit is due upon registration. Monthly payments are due on the 15th prior to each month. Price: HiddenCoupon - Hidden Coupon Total - Hidden for now $0.00 Deposit | Refund | Cancellation Policy* I accept the Deposit | Refund | Cancellation Policy. TLL fees and tuitions are non-refundable and non-transferable. However, if given reasonable time to try and fill a spot, we can transfer a deposit to another event, within a year, based upon availability. We do not provide credit for absences, no-shows, withdrawals, or program dissatisfaction. In the rare event that we must cancel an offering, we will offer an appropriate refund.Limitations and Occasions to Refer Policy* I accept the Limitations and Occasions to Refer Policy. TLL strives to offer clients the highest standards of professional support and care. To do so, TLL combines some of the most effective techniques and practices of consulting, coaching, and counseling; however, TLL does not claim to deliver professional psychological, psychotherapeutic, or mental health services. While some of our coaches and trainers are pre-licensed or licensed mental health therapists, they are not practicing as such as part of TLL. When issues such as active addiction, historic trauma, and mental health disorders emerge, TLL will offer to refer the Client to additional help.